Acute and Sustained Reductions in Loss of Meaning and Suicidal Ideation Following Psilocybin-Assisted Psychotherapy for Psychiatric and Existential Distress in Life-Threatening Cancer

Summary & key facts

Researchers looked at people with life-threatening cancer who often feel hopeless, lose meaning in life, or think about suicide. In a carefully controlled study, some people received psilocybin together with psychotherapy. Those people showed big drops in suicidal thoughts within hours and felt more meaning and less demoralization within weeks. The benefits lasted for months and were still measurable years later. The results are promising but preliminary, and the researchers say more study is needed before saying this should replace current treatments.

Key facts:

• The study tested psilocybin given with psychotherapy in people with advanced cancer who often have hopelessness and loss of meaning.
• Among participants who had notable suicidal thoughts before treatment, suicidal thinking fell as soon as 8 hours after the psilocybin session.
• The reductions in suicidal thinking after psilocybin lasted for about 6.5 months on average in the group studied.
• Feelings of loss of meaning dropped a lot by two weeks after treatment and remained significantly lower at follow-ups about 6.5 months later and again at roughly 3 and 4.5 years.
• Analyses in this paper suggest the treatment may reduce suicidal thinking partly by reducing hopelessness and loss of meaning.
• The authors call these results preliminary. They note the findings support more research, especially in people with higher levels of depression and suicidality, before changing treatment recommendations.

Abstract

People with advanced cancer are at heightened risk of desire for hastened death (DHD), suicidal ideation (SI), and completed suicide. Loss of Meaning (LoM), a component of demoralization, can be elevated by a cancer diagnosis and predicts DHD and SI in this population. We completed a randomized controlled trial in which psilocybin-assisted psychotherapy (PAP) produced rapid and sustained improvements in depression, demoralization, and hopelessness in people with cancer. Converging epidemiologic and clinical trial findings suggests a potential antisuicidal effect of this treatment. To probe our hypothesis that PAP relieves SI through its beneficial impacts on depression and demoralization (LoM in particular), we performed secondary analyses assessing within- and between-group differences with regard to LoM and an SI composite score. Among participants with elevated SI at baseline, PAP was associated with within-group reductions in SI that were apparent as early as 8 h and persisted for 6.5 months postdosing. PAP also produced large reductions in LoM from baseline that were apparent 2 weeks after treatment and remained significant and robust at the 6.5 month and 3.2 and 4.5 year follow-ups. Exploratory analyses support our hypothesis and suggest that PAP may be an effective antisuicidal intervention following a cancer diagnosis due to its positive impact on hopelessness and demoralization and its effects on meaning-making in particular. These preliminary results implicate psilocybin treatment as a potentially effective alternative to existing antidepressant medications in patients with cancer that are also suicidal, and warrant further investigation in participants with elevated levels of depression and suicidality.

Topics

Body Image and Dysmorphia Studies Complementary and Alternative Medicine Studies Psychedelics and Drug Studies

Categories

Clinical Psychology Psychology Social Sciences

Tags

Cancer Clinical psychology Clinical trial Depression (economics) Distress Economics Environmental health Hallucinogen Internal medicine Intervention (counseling) Macroeconomics Medicine Poison control Population Psilocybin Psychiatry Psychology Psychotherapist Randomized controlled trial Suicidal ideation Suicide prevention

Substances

Psilocybin

Conditions & symptoms

Depression Feeling disconnected from others Lack of energy or motivation Sadness or low mood